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1、房顫導(dǎo)管消融---適應(yīng)證選擇房顫患病率逐年增加AdultswithAFib(millions)Year2.082.262.442.662.943.333.804.784.345.165.425.61%363753YearProportionAged?80YrGo:JAMA,2001：2370中國1000萬國內(nèi)房顫的流行病學(xué)研究房顫患者腦中風(fēng)風(fēng)險(xiǎn)17.5%瓣膜病房顫患者腦中風(fēng)風(fēng)險(xiǎn)26.88%非瓣膜病房顫患者腦中風(fēng)風(fēng)險(xiǎn)24.15%HuDY,ChinJInternMed2003;42:157–61.Wen-HangQI.IntJCardiol2005;105:283–7.Zhang
2、S.Heart2009Jul;95(13):1052-5.2012ESC----房顫導(dǎo)管消融指南成功標(biāo)準(zhǔn):術(shù)后12個(gè)月陣發(fā):50%持續(xù):40%長程:30%慢性房顫消融 ---適應(yīng)證的個(gè)體化策略臨床病例病例271歲，女性AF病史83個(gè)月高血壓糖尿病LA56mmRA56x46mmMR、TR中度返流病例143歲，男性AF病史14個(gè)月LA41mm不同特點(diǎn)的患者---完全相同的術(shù)式？適應(yīng)證的個(gè)體化依據(jù)何在臨床特征病史合并疾病心臟超聲電生理特征肺靜脈電位碎裂電位雙心房電學(xué)差異預(yù)后與復(fù)發(fā)復(fù)發(fā)時(shí)間復(fù)發(fā)類型復(fù)發(fā)次數(shù)依據(jù)何在*Yuanglongw,XuL,etal.Theevalutionofl
3、eftandatrialatriumlinesablationforlongstandingatrialfibrillation.PACE.onlines適應(yīng)證的個(gè)體化適應(yīng)證的個(gè)體化220patientswithLS-AFGroupI：CPVI+CFAEsGroupII:I+Lines(roof+mitralismuths)GroupIII:II+Lines(roof+mitralismuths+thricuspidismuths)Currentablationendpoints:CPVI+CFAEs+Lines(roof+mitralismuths)(CCL)步驟1環(huán)肺靜脈
4、電隔離步驟2碎裂電位消融步驟3必要的線性消融AF終止AF終止AF未終止AF未終止電復(fù)律本中心慢性房顫CCL消融策略探索CPVI+CFAEs+Lines(CCL)WangYY,LiuXu,etal.Evaluationoflinearlesionsintheleftandrightatriuminablationoflongstandingatrialfibrillation.PacingandClinicalElectrophysiology.2013.Acceptted.依據(jù)-臨床特征-年齡258patientswithLS-AFCurrentablationendpoin
5、ts---CCLGroupI(≤55yrs),GroupII(56–65yrs),GroupIII(≥66years)follow-upof18.1±5.1months*XiaodongZ,LiangZ,XuL,etal.Theimpactofageontheefficacyandsafetyofcatheterablation.IntJCardiol,online.SRgroupandrecurrentATagroup適應(yīng)證的個(gè)體化*XiaodongZ,LiangZ,XuL,etal.Theimpactofageontheefficacyandsafetyofcathete
6、rablation.IntJCardiol,online.依據(jù)-臨床特征-年齡適應(yīng)證的個(gè)體化*XiaodongZ,LiangZ,XuL,etal.Theimpactofageontheefficacyandsafetyofcatheterablation.IntJCardiol,online.依據(jù)-臨床特征-年齡適應(yīng)證的個(gè)體化依據(jù)-臨床特征-性別220patientswithLS-AFCurrentablationendpoints---CCL147malesand73femalesfollow-upof19±5.0months*XiaodongZ,LiangZ,XuL,et
7、al.Efficacyandsafetyofcatheterablationforlong-standingpersistentatrialfibrillationinwomen.PACE,accepted.SRgroupandrecurrentATagroup適應(yīng)證的個(gè)體化依據(jù)-臨床特征-性別*XiaodongZ,LiangZ,XuL,etal.Efficacyandsafetyofcatheterablationforlong-standingpersistentatrialfibrillation
